Hepatitis C virus infection and anaesthesia practice: A narrative review

Abstract

This paper reviews the natural and treated history of hepatitis C virus infection, the interactions between current therapies and anaesthesia medications, and the implications of occupational exposure and infection to anaesthetists in light of significant changes in treatment. In the past decade, the introduction of new direct acting antiviral medications has seen high cure rates with a sustained viral response across all virus genotypes. These medications are well tolerated with minimal side-effects. Should a patient on these medications require anaesthesia, there are few clinically significant interactions with commonly used anaesthesia medications, and minimal perioperative investigations are required, although delaying elective surgery until after the completion of treatment regimens should be considered to maximise treatment success. As anaesthetists may practise exposure-prone procedures, regular screening for hepatitis C virus infection remains recommended to enable both patient protection and treatment of the anaesthetist prior to the development of any long-term complications of hepatitis C virus infection. Similarly, early diagnosis and treatment of occupationally acquired hepatitis C virus infection after body fluid exposure is associated with high cure rates with minimal risk of long-term liver damage. Although hepatitis C virus infection remains a significant public health issue in Australia and New Zealand, improvements in outcomes as a result of new treatment regimens have allowed the World Health Organization to target the elimination of hepatitis C virus infection as a public health threat by 2030, and public health strategies are being implemented to achieve this goal.